- Theo doi thifdng xuyen mach, HADM ap kpe TM TW vit so lifting nude til u, day la chi so danh gia b^nh nhan diityc truy&i du djch hay khfing.
6. CAC BIEN CHtfNG 1 Gay xtfdng hcf
6.1. Gay xtfdng hcf
Mo cat loc, rach rong, tuy do gay ho ma co phtfdng phap co dinh xtfdng khac nhau. Neu gay hd nho (do 1-2) den s6m, co the ket hdp xtfdng ngay
Gay xtfdng hd nang (do 3), den muon: thi co dinh ngoai bang khung Hoffm ann hoac bo bot canh-cSng-ban tay (neu khong co khung).
6.2. Hoi chtfng chen ep khoang cang tay: co the gay xtfdng hoac khong (hinh 18.8, 18.9)
6.2.1. Lam sang
- Ca ciing tay cang cting, tron nhtf mot cai ong
- Tang cam giac dau ngoai da, nhat la khi van dong thu dong cac ngon tay. - Cac ngon tay ne to, tim va lanh hdn binh thtfdng
- Liet van dong va mat cam giac cac ngon tay
- Mach quay va mach tru kho bat, nang hdn la khong bat dtfdc (giai doan muon) Khoang nong
Thanh b§n
Khoang s3u
Hinh 18.9. Cd the chan thi/dng gay nen hoi chirng chen ep khoang cang tay
6.2.2. Can lam sang
• Do dp ltfc khoang (Pk) bang phtfdng phap W hiteside (hinh 18.10a)
Choc kim to vao khoang, do ap lilc th u y tlnh cu a cot nUdc d u n g d ich sinh ly bdm vao trong khoang.
Dung cu do: vdi 3 chac, ong tiem 20ml, 2 ong nhtfa, 1 kim cd 18, ap ke thuy ngan, chai huyet thanh man d in g trUdng.
C) mdi khoang can do it nhat 2 ndi
- Binh thUdng ap ltfc khoang: 8-10m m H g
- Khi ap ltfc khoang >30m m H g: rach can; giai phong khoang (hinh 18.10b)
Nghi ngd hoi chifng khoang
Trieu chifng lam sang ro
Benh nhan hon me Da chan thifOng
Trieu chifng lam sang khong ro 1
Do ap life khoang
i— - — i
30mmHg < 30mmHg i Theo doi ap li/c khoang va 15m sang«-| j < 30 1 mmHg Trieu chi/ng lam sang ro > 30mmHg M d C A N
Hinh 18.10b. ScJ do theo doi hoi chung chen ep khoang
• Do giao dong dong m ach: bang sieu dm D oppler
- Ltfu thong mau phia ha lUu giam hoac gian doan
- Dung D oppler mau de do dtfdc ap ltfc dong chay mot cach chinh xac hdn.
6.2.3. Chup phim X quang
- Chup X quang thtfdng de chan doan xac dinh gay xtfdng
- Chup m ach mau co thuoc can quang de xac dinh chinh xac ton thtfdng mach mau. Day la phtfdng phap chinh xac nhat nhtfng khong phai luc nao cung lam dUdc va benh vien nao cung lam dUdc trong cap ctfu.
- Chup C.T de xac dinh mtfc do hoai tti cd trong khoang
6.2.4. Cac xet nghiem
- Xet nghiem mau de biet mtfc do mat mau
- Xet nghiem sinh hoa mau (Ure, Creatinin, C.P.K) de xac dinh chtfc nang gan-than.